Healthcare Provider Details

I. General information

NPI: 1437808730
Provider Name (Legal Business Name): AUDREY MICHELLE WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/05/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVE, ML 5026
CINCINNATI OH
45229
US

IV. Provider business mailing address

3430 BURNET AVE, ML 5026
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7722
  • Fax: 513-636-3737
Mailing address:
  • Phone: 513-636-7722
  • Fax: 513-636-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.152767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: